From the FDA Drug Label
Quetiapine was excreted into human milk. Because of the potential for serious adverse reactions in nursing infants from quetiapine, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother’s health In published case reports, the level of quetiapine in breast milk ranged from undetectable to 170 μg/L. The estimated infant dose ranged from 0.09% to 0.43% of the weight-adjusted maternal dose.
No antipsychotic is explicitly stated as safe for use during postpartum lactation (breastfeeding) for treating severe anxiety in the provided drug labels.
- The labels suggest that quetiapine is excreted into human milk and may cause serious adverse reactions in nursing infants.
- Due to the potential risks, a decision should be made to either discontinue nursing or discontinue the drug, considering the importance of the drug to the mother's health 1.
- There is no direct information provided about the safety of other antipsychotics during breastfeeding for treating severe anxiety.
From the Research
Antipsychotics such as quetiapine and olanzapine can be used safely while breastfeeding for severe postpartum anxiety, but non-pharmacological interventions should be considered first, as they have been shown to be effective in reducing anxiety during the postpartum period 2. When considering antipsychotics, quetiapine (starting at 25-50mg at bedtime) and olanzapine (2.5-5mg daily) are generally considered among the safer options due to their low infant exposure. Some key points to consider when using antipsychotics while breastfeeding include:
- Starting with the lowest effective dose
- Monitoring the infant for drowsiness, poor feeding, or developmental concerns
- Considering the timing of medication to minimize exposure, such as taking it right after breastfeeding or before the infant's longest sleep period
- Using these medications as part of a comprehensive approach including therapy and support
- Always discussing with both a psychiatrist and pediatrician to weigh individual benefits and risks, as the mother's mental health is crucial for infant wellbeing. It's also important to note that non-pharmacological interventions, such as cognitive behavioral therapy, yoga, music therapy, and relaxation, have been shown to be effective in reducing anxiety during the postpartum period 2, and should be considered as a first-line treatment. Additionally, some studies suggest that selective serotonin reuptake inhibitors (SSRIs) such as sertraline and paroxetine are considered relatively safe to use during breastfeeding, with low infant exposure 3, 4. However, the use of antipsychotics during breastfeeding should be approached with caution, and the benefits and risks should be carefully weighed, taking into account the individual circumstances of the mother and the infant. It's also worth noting that the most recent and highest quality study on this topic is from 2024, which provides a summary of information on the pharmacological treatment options for maternal depression during lactation and the concurrent effects on the breastfeeding infant 4.